Scientific American September 2009
PDF | English | 21MB
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PDF | English | 21MB
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الأحد، 30 أغسطس 2009
Hereditary Tumors
Hereditary Tumors : From Genes to Clinical Consequences
Wiley-VCH | 2009-03-03 | ISBN: 3527320288 | 559 Pages | PDF | 3,2 MB
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Wiley-VCH | 2009-03-03 | ISBN: 3527320288 | 559 Pages | PDF | 3,2 MB
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or
Another View of the Brain System
Another View of the Brain System
Nova Biomedical Books | 2009-01 | ISBN: 1606925938 | 214 Pages | PDF | 7 MB
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Nova Biomedical Books | 2009-01 | ISBN: 1606925938 | 214 Pages | PDF | 7 MB
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or
Psychotherapist Revealed
Psychotherapist Revealed : Therapists Speak About Self-Disclosure in Psychotherapy
Publisher : Routledge | 303 Pages | 2009-05-14 | ISBN: 0415963834 | PDF | 6.35 MB
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Publisher : Routledge | 303 Pages | 2009-05-14 | ISBN: 0415963834 | PDF | 6.35 MB
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or
Modern Pharmaceutics, Fifth Edition, Volume 2 : Applications and Advances
Modern Pharmaceutics, Fifth Edition, Volume 2 : Applications and Advances
Informa HealthCare | 2009-05-28 | ISBN: 1420065661 | 560 Pages | PDF | 6,8 MB
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Informa HealthCare | 2009-05-28 | ISBN: 1420065661 | 560 Pages | PDF | 6,8 MB
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الجمعة، 28 أغسطس 2009
Acupuncture: Treatments of Musculoskeletal Conditions
Acupuncture: Treatments of Musculoskeletal Conditions Summary:
By Christopher M. Norris
Publisher: Elsevier Limited
Number Of Pages: 206
Publication Date: 2001-10-15
ISBN-10 / ASIN: 0750651733
ISBN-13 / EAN: 9780750651738
Product Description:
Practical handbook combines traditional Chinese and Western acupuncture with modern physiotherapy techniques. Includes illustrations and clinical guidance. Treatment protocols are also included. For professionals interested in the subject. Softcover. DNLM: Acupuncture Points.
download link
http://ebook30.com/auth/login/
العلاج بالرمال السخنة والمياة المعدنية والكبريتية
اشتهرت مصر بمدنها ومياهها المعدنية والكبريتية وجوها الجاف الخالى من الرطوبة وماتحتويه تربتها من رمال وطمى صالح لعلاج الأمراض العديدة ، وتـعدد شواطئها ومياه بحارها بما لها من خواص طبيعية مميزة .
وقد انتشرت فى مصر العيون الكبريتية والمعدنية التى تمتاز بتركيبها الكيميائى الفريد . والذى يفوق فى نسبته جميع العيون الكبريتية والمعدنية فى العالم . علاوة على توافر الطمى فى برك هذه العيون الكبريتية بما له من خواص علاجية تشفى العديد من امراض العظام وامراض الجهاز الهضمى والجهاز التنفسى والامراض الجلدية وغيرها ، كما ثبت ايضا الاستشفاء لمرضى الروماتيزم المفصلى عن طريق الدفن فى الرمال .
كما اكدت الأبحاث أن مياه البحر الاحمر بمحتواها الكيميائى ووجود الشعاب المرجانية فيها تساعد على الاستشفاء من مرض الصدفية . وتتعدد المناطق السياحية التى تتمتع بميزة السياحة العلاجية فى مصر وهى مناطق ذات شهرة تاريخية عريقة مثل : حلوان ، عين الصيرة ، العين السخنة ، الغردقة ، الفيوم ، منطقة الواحات ، اسوان ، سيناء ، واخيراً مدينة سفاجا الرابضة على شاطىء البحر الاحمر والتى تمتلك جميع عناصر السياحة العلاجية والتى تزورها الأفواج السياحية وتأتى شهرتها بأن الرمال السوداء لها القدرة على التخلص من بعض الأمراض الجلدية .
وقد اعتقد المصريون القدماء أن الانسان سوف يبعث ثانية بعد موته ليحيا حياة الخلود ولذا حرصوا على الاحتفاظ بأجساد الموتى عن طريق تحنيطها , والتحنيط عملية يقصد بها قدماء المصريين , كما راعوا دفن جثث الموتى بعيداً عن رشح المياه ووضعوها فى قبور حصينة فى الاماكن الجافة فى الصحراء وفى داخل الاهرامات , وكانت هذه العمليات تتم فى ظل علوم طبية متقدمة واطباء أكفاء قادرين على استخدام كل ما تجود به الطبيعة من مواد صيدلية وكيمائية .
وقبل مولد المسيح بثلاثة آلاف عام انجبت مصر " ايمحوتب " عميد الطب العالمى ورائده الأول باجماع المؤرخين . ويعنى أسمه الهيروغليفى الذى يأتى فى سلام " أنه الطبيب المعمارى الوزير كبير الكهنة المرتلين , وفوق ذلك كله رافع أول صرح حجرى فى التاريخ : هرم الملك " زوسر " المدرج بسقارة .
ويوم كانت الانسانية بعد فى طفولتها الأولى أهدتها مصر فى " أيمحوتب " عبقرية طبية , ويقول عنه " جيمس هنرى برستد " وكورت زيته " أنه المخترع الأول لفن الطب بلا منافس . عبد فى منف كإله للشفاء . وقال فيه " أوسلى " : أنه أول صورة لطبيب واقعى , واصبح إلهاً شعبياً محبوباً .
وبتزايد الكشوف الأثرية التى تركها على مر الزمن بزغت الأهمية الطبية والعلاجية للعديد من المواقع فى أرجاء مصر مثل حلوان والفيوم وجنوب سيناء وسفاجا لما تتمتع به هذه الاماكن من مياه معدنية ورمال وكثبان قادرة على علاج وشفاء العديد من الامراض المستعصية فى عالمنا اليوم مثل الامراض الجلدية والروماتزمية .
ولقد أدركت الدولة الأهمية الطبية والعلاجية لهذه الأماكن فقامت على رعايتها والاهتمام بها حيث صارت من أرقى أماكن الاستشفاء العالمية .
وهكذا أحتلت مصر موقعاً متميزاً على خريطة السياحة العلاجية واصبحت مقصداً لراغبى الاستشفاء من جميع انحاء العالم حيث يأتى اليها السائحون للأستمتاع بالمناخ الصحى والعلاج الطبى الطبيعى تحت رعاية أطباء متخصصين فى جميع الفروع والمستشفيات الحديثة التى يتوافر بها أحدث الاجهزة العالمية يساندهم أخصائيون فى التمرين والعلاج الطبيعى على أعلى مستوى من الخدمة .الى جانب تقديم برامج سياحية متنوعة لزيارة الاماكن السيحية الفريدة فى مصر.
الاستشفاء الطبيعى بمصر:
تنتشر فى مصر مئات من العيون والآبار الطبيعية ذات المياه المعدنية والكبريتية , تختلف فى العمق والسعة ودرجة الحرارة بين 30 , 73 درجة مئوية. وقد أثبتت التحليلات المعملية احتواء الكثير من هذه الينابيع الطبيعية على أعلى نسبة من عنصر الكبريت مقارنة بالأبار المنتشرة فى شتى أنحاء العالم كما تحتوى هذه المياه الطبيعية على عدة أملاح معدنية وبعض المعادن ذات القيمة العلاجية من أمثال كربونات الصوديوم ونسب متفاوتة من بعض العناصر الفلزية مثل الماغنسيوم والحديد .
كما أظهرت القياسات المعملية ملاءمة نسبة الملوحة فى هذه الموارد المائية الطبيعية للأغراض الاستشفائية ويضاف الى ذلك انتشار آبار المياه الطبيعية النقية الصالحة للشرب , والتى توسعت مصر فى استثمارها وإنتاجها على نحو إقتصادى فى السنوات الأخيرة فى إطار رقابة علمية صارمة على الجودة والمواصفات القياسية من حيث النقاء من الشوائب والطفيليات والجراثيم , ودرجة عسر الماء والتركيب الكيميائى , مما دفع بالعديد من الشركات الوطنية والأجنبية الكبرى الى التنافس للاستثمار فى هذا المجال .
ولم تكن رمال مصر أقل ثراء من مياها فقد أظهرت الدراسات احتواء الكثبان الرملية بالصحراء المصرية على نسب مأمونة وعظيمة الفائدة من العناصر المشعة , وقد أدى العلاج بطمر الجسم أو الوضع المؤلم منه بالرمال لفترات مدروسة ومحددة الى نتائج غير مسبوقة فى عدة أمراض روماتزمية مثل مرض الروماتويد والآلام الناجمة عن أمراض العمود الفقرى وغير ذلك من اسباب الألم الحاد والمزمن , مما يحار فيه الطب الحديث.
وقد انتشرت فى مصر العيون الكبريتية والمعدنية التى تمتاز بتركيبها الكيميائى الفريد . والذى يفوق فى نسبته جميع العيون الكبريتية والمعدنية فى العالم . علاوة على توافر الطمى فى برك هذه العيون الكبريتية بما له من خواص علاجية تشفى العديد من امراض العظام وامراض الجهاز الهضمى والجهاز التنفسى والامراض الجلدية وغيرها ، كما ثبت ايضا الاستشفاء لمرضى الروماتيزم المفصلى عن طريق الدفن فى الرمال .
كما اكدت الأبحاث أن مياه البحر الاحمر بمحتواها الكيميائى ووجود الشعاب المرجانية فيها تساعد على الاستشفاء من مرض الصدفية . وتتعدد المناطق السياحية التى تتمتع بميزة السياحة العلاجية فى مصر وهى مناطق ذات شهرة تاريخية عريقة مثل : حلوان ، عين الصيرة ، العين السخنة ، الغردقة ، الفيوم ، منطقة الواحات ، اسوان ، سيناء ، واخيراً مدينة سفاجا الرابضة على شاطىء البحر الاحمر والتى تمتلك جميع عناصر السياحة العلاجية والتى تزورها الأفواج السياحية وتأتى شهرتها بأن الرمال السوداء لها القدرة على التخلص من بعض الأمراض الجلدية .
وقد اعتقد المصريون القدماء أن الانسان سوف يبعث ثانية بعد موته ليحيا حياة الخلود ولذا حرصوا على الاحتفاظ بأجساد الموتى عن طريق تحنيطها , والتحنيط عملية يقصد بها قدماء المصريين , كما راعوا دفن جثث الموتى بعيداً عن رشح المياه ووضعوها فى قبور حصينة فى الاماكن الجافة فى الصحراء وفى داخل الاهرامات , وكانت هذه العمليات تتم فى ظل علوم طبية متقدمة واطباء أكفاء قادرين على استخدام كل ما تجود به الطبيعة من مواد صيدلية وكيمائية .
وقبل مولد المسيح بثلاثة آلاف عام انجبت مصر " ايمحوتب " عميد الطب العالمى ورائده الأول باجماع المؤرخين . ويعنى أسمه الهيروغليفى الذى يأتى فى سلام " أنه الطبيب المعمارى الوزير كبير الكهنة المرتلين , وفوق ذلك كله رافع أول صرح حجرى فى التاريخ : هرم الملك " زوسر " المدرج بسقارة .
ويوم كانت الانسانية بعد فى طفولتها الأولى أهدتها مصر فى " أيمحوتب " عبقرية طبية , ويقول عنه " جيمس هنرى برستد " وكورت زيته " أنه المخترع الأول لفن الطب بلا منافس . عبد فى منف كإله للشفاء . وقال فيه " أوسلى " : أنه أول صورة لطبيب واقعى , واصبح إلهاً شعبياً محبوباً .
وبتزايد الكشوف الأثرية التى تركها على مر الزمن بزغت الأهمية الطبية والعلاجية للعديد من المواقع فى أرجاء مصر مثل حلوان والفيوم وجنوب سيناء وسفاجا لما تتمتع به هذه الاماكن من مياه معدنية ورمال وكثبان قادرة على علاج وشفاء العديد من الامراض المستعصية فى عالمنا اليوم مثل الامراض الجلدية والروماتزمية .
ولقد أدركت الدولة الأهمية الطبية والعلاجية لهذه الأماكن فقامت على رعايتها والاهتمام بها حيث صارت من أرقى أماكن الاستشفاء العالمية .
وهكذا أحتلت مصر موقعاً متميزاً على خريطة السياحة العلاجية واصبحت مقصداً لراغبى الاستشفاء من جميع انحاء العالم حيث يأتى اليها السائحون للأستمتاع بالمناخ الصحى والعلاج الطبى الطبيعى تحت رعاية أطباء متخصصين فى جميع الفروع والمستشفيات الحديثة التى يتوافر بها أحدث الاجهزة العالمية يساندهم أخصائيون فى التمرين والعلاج الطبيعى على أعلى مستوى من الخدمة .الى جانب تقديم برامج سياحية متنوعة لزيارة الاماكن السيحية الفريدة فى مصر.
الاستشفاء الطبيعى بمصر:
تنتشر فى مصر مئات من العيون والآبار الطبيعية ذات المياه المعدنية والكبريتية , تختلف فى العمق والسعة ودرجة الحرارة بين 30 , 73 درجة مئوية. وقد أثبتت التحليلات المعملية احتواء الكثير من هذه الينابيع الطبيعية على أعلى نسبة من عنصر الكبريت مقارنة بالأبار المنتشرة فى شتى أنحاء العالم كما تحتوى هذه المياه الطبيعية على عدة أملاح معدنية وبعض المعادن ذات القيمة العلاجية من أمثال كربونات الصوديوم ونسب متفاوتة من بعض العناصر الفلزية مثل الماغنسيوم والحديد .
كما أظهرت القياسات المعملية ملاءمة نسبة الملوحة فى هذه الموارد المائية الطبيعية للأغراض الاستشفائية ويضاف الى ذلك انتشار آبار المياه الطبيعية النقية الصالحة للشرب , والتى توسعت مصر فى استثمارها وإنتاجها على نحو إقتصادى فى السنوات الأخيرة فى إطار رقابة علمية صارمة على الجودة والمواصفات القياسية من حيث النقاء من الشوائب والطفيليات والجراثيم , ودرجة عسر الماء والتركيب الكيميائى , مما دفع بالعديد من الشركات الوطنية والأجنبية الكبرى الى التنافس للاستثمار فى هذا المجال .
ولم تكن رمال مصر أقل ثراء من مياها فقد أظهرت الدراسات احتواء الكثبان الرملية بالصحراء المصرية على نسب مأمونة وعظيمة الفائدة من العناصر المشعة , وقد أدى العلاج بطمر الجسم أو الوضع المؤلم منه بالرمال لفترات مدروسة ومحددة الى نتائج غير مسبوقة فى عدة أمراض روماتزمية مثل مرض الروماتويد والآلام الناجمة عن أمراض العمود الفقرى وغير ذلك من اسباب الألم الحاد والمزمن , مما يحار فيه الطب الحديث.
اشتهرت مصر بمدنها ومياهها المعدنية والكبريتية وجوها الجاف الخالى من الرطوبة وماتحتويه تربتها من رمال وطمى صالح لعلاج الأمراض العديدة ، وتـعدد شواطئها ومياه بحارها بما لها من خواص طبيعية مميزة .
وقد انتشرت فى مصر العيون الكبريتية والمعدنية التى تمتاز بتركيبها الكيميائى الفريد . والذى يفوق فى نسبته جميع العيون الكبريتية والمعدنية فى العالم . علاوة على توافر الطمى فى برك هذه العيون الكبريتية بما له من خواص علاجية تشفى العديد من امراض العظام وامراض الجهاز الهضمى والجهاز التنفسى والامراض الجلدية وغيرها ، كما ثبت ايضا الاستشفاء لمرضى الروماتيزم المفصلى عن طريق الدفن فى الرمال .
كما اكدت الأبحاث أن مياه البحر الاحمر بمحتواها الكيميائى ووجود الشعاب المرجانية فيها تساعد على الاستشفاء من مرض الصدفية . وتتعدد المناطق السياحية التى تتمتع بميزة السياحة العلاجية فى مصر وهى مناطق ذات شهرة تاريخية عريقة مثل : حلوان ، عين الصيرة ، العين السخنة ، الغردقة ، الفيوم ، منطقة الواحات ، اسوان ، سيناء ، واخيراً مدينة سفاجا الرابضة على شاطىء البحر الاحمر والتى تمتلك جميع عناصر السياحة العلاجية والتى تزورها الأفواج السياحية وتأتى شهرتها بأن الرمال السوداء لها القدرة على التخلص من بعض الأمراض الجلدية .
وقد اعتقد المصريون القدماء أن الانسان سوف يبعث ثانية بعد موته ليحيا حياة الخلود ولذا حرصوا على الاحتفاظ بأجساد الموتى عن طريق تحنيطها , والتحنيط عملية يقصد بها قدماء المصريين , كما راعوا دفن جثث الموتى بعيداً عن رشح المياه ووضعوها فى قبور حصينة فى الاماكن الجافة فى الصحراء وفى داخل الاهرامات , وكانت هذه العمليات تتم فى ظل علوم طبية متقدمة واطباء أكفاء قادرين على استخدام كل ما تجود به الطبيعة من مواد صيدلية وكيمائية .
وقبل مولد المسيح بثلاثة آلاف عام انجبت مصر " ايمحوتب " عميد الطب العالمى ورائده الأول باجماع المؤرخين . ويعنى أسمه الهيروغليفى الذى يأتى فى سلام " أنه الطبيب المعمارى الوزير كبير الكهنة المرتلين , وفوق ذلك كله رافع أول صرح حجرى فى التاريخ : هرم الملك " زوسر " المدرج بسقارة .
ويوم كانت الانسانية بعد فى طفولتها الأولى أهدتها مصر فى " أيمحوتب " عبقرية طبية , ويقول عنه " جيمس هنرى برستد " وكورت زيته " أنه المخترع الأول لفن الطب بلا منافس . عبد فى منف كإله للشفاء . وقال فيه " أوسلى " : أنه أول صورة لطبيب واقعى , واصبح إلهاً شعبياً محبوباً .
وبتزايد الكشوف الأثرية التى تركها على مر الزمن بزغت الأهمية الطبية والعلاجية للعديد من المواقع فى أرجاء مصر مثل حلوان والفيوم وجنوب سيناء وسفاجا لما تتمتع به هذه الاماكن من مياه معدنية ورمال وكثبان قادرة على علاج وشفاء العديد من الامراض المستعصية فى عالمنا اليوم مثل الامراض الجلدية والروماتزمية .
ولقد أدركت الدولة الأهمية الطبية والعلاجية لهذه الأماكن فقامت على رعايتها والاهتمام بها حيث صارت من أرقى أماكن الاستشفاء العالمية .
وهكذا أحتلت مصر موقعاً متميزاً على خريطة السياحة العلاجية واصبحت مقصداً لراغبى الاستشفاء من جميع انحاء العالم حيث يأتى اليها السائحون للأستمتاع بالمناخ الصحى والعلاج الطبى الطبيعى تحت رعاية أطباء متخصصين فى جميع الفروع والمستشفيات الحديثة التى يتوافر بها أحدث الاجهزة العالمية يساندهم أخصائيون فى التمرين والعلاج الطبيعى على أعلى مستوى من الخدمة .الى جانب تقديم برامج سياحية متنوعة لزيارة الاماكن السيحية الفريدة فى مصر.
الاستشفاء الطبيعى بمصر:
تنتشر فى مصر مئات من العيون والآبار الطبيعية ذات المياه المعدنية والكبريتية , تختلف فى العمق والسعة ودرجة الحرارة بين 30 , 73 درجة مئوية. وقد أثبتت التحليلات المعملية احتواء الكثير من هذه الينابيع الطبيعية على أعلى نسبة من عنصر الكبريت مقارنة بالأبار المنتشرة فى شتى أنحاء العالم كما تحتوى هذه المياه الطبيعية على عدة أملاح معدنية وبعض المعادن ذات القيمة العلاجية من أمثال كربونات الصوديوم ونسب متفاوتة من بعض العناصر الفلزية مثل الماغنسيوم والحديد .
كما أظهرت القياسات المعملية ملاءمة نسبة الملوحة فى هذه الموارد المائية الطبيعية للأغراض الاستشفائية ويضاف الى ذلك انتشار آبار المياه الطبيعية النقية الصالحة للشرب , والتى توسعت مصر فى استثمارها وإنتاجها على نحو إقتصادى فى السنوات الأخيرة فى إطار رقابة علمية صارمة على الجودة والمواصفات القياسية من حيث النقاء من الشوائب والطفيليات والجراثيم , ودرجة عسر الماء والتركيب الكيميائى , مما دفع بالعديد من الشركات الوطنية والأجنبية الكبرى الى التنافس للاستثمار فى هذا المجال .
ولم تكن رمال مصر أقل ثراء من مياها فقد أظهرت الدراسات احتواء الكثبان الرملية بالصحراء المصرية على نسب مأمونة وعظيمة الفائدة من العناصر المشعة , وقد أدى العلاج بطمر الجسم أو الوضع المؤلم منه بالرمال لفترات مدروسة ومحددة الى نتائج غير مسبوقة فى عدة أمراض روماتزمية مثل مرض الروماتويد والآلام الناجمة عن أمراض العمود الفقرى وغير ذلك من اسباب الألم الحاد والمزمن , مما يحار فيه الطب الحديث.
اشتهرت مصر بمدنها ومياهها المعدنية والكبريتية وجوها الجاف الخالى من الرطوبة وماتحتويه تربتها من رمال وطمى صالح لعلاج الأمراض العديدة ، وتـعدد شواطئها ومياه بحارها بما لها من خواص طبيعية مميزة .
وقد انتشرت فى مصر العيون الكبريتية والمعدنية التى تمتاز بتركيبها الكيميائى الفريد . والذى يفوق فى نسبته جميع العيون الكبريتية والمعدنية فى العالم . علاوة على توافر الطمى فى برك هذه العيون الكبريتية بما له من خواص علاجية تشفى العديد من امراض العظام وامراض الجهاز الهضمى والجهاز التنفسى والامراض الجلدية وغيرها ، كما ثبت ايضا الاستشفاء لمرضى الروماتيزم المفصلى عن طريق الدفن فى الرمال .
كما اكدت الأبحاث أن مياه البحر الاحمر بمحتواها الكيميائى ووجود الشعاب المرجانية فيها تساعد على الاستشفاء من مرض الصدفية . وتتعدد المناطق السياحية التى تتمتع بميزة السياحة العلاجية فى مصر وهى مناطق ذات شهرة تاريخية عريقة مثل : حلوان ، عين الصيرة ، العين السخنة ، الغردقة ، الفيوم ، منطقة الواحات ، اسوان ، سيناء ، واخيراً مدينة سفاجا الرابضة على شاطىء البحر الاحمر والتى تمتلك جميع عناصر السياحة العلاجية والتى تزورها الأفواج السياحية وتأتى شهرتها بأن الرمال السوداء لها القدرة على التخلص من بعض الأمراض الجلدية .
وقد اعتقد المصريون القدماء أن الانسان سوف يبعث ثانية بعد موته ليحيا حياة الخلود ولذا حرصوا على الاحتفاظ بأجساد الموتى عن طريق تحنيطها , والتحنيط عملية يقصد بها قدماء المصريين , كما راعوا دفن جثث الموتى بعيداً عن رشح المياه ووضعوها فى قبور حصينة فى الاماكن الجافة فى الصحراء وفى داخل الاهرامات , وكانت هذه العمليات تتم فى ظل علوم طبية متقدمة واطباء أكفاء قادرين على استخدام كل ما تجود به الطبيعة من مواد صيدلية وكيمائية .
وقبل مولد المسيح بثلاثة آلاف عام انجبت مصر " ايمحوتب " عميد الطب العالمى ورائده الأول باجماع المؤرخين . ويعنى أسمه الهيروغليفى الذى يأتى فى سلام " أنه الطبيب المعمارى الوزير كبير الكهنة المرتلين , وفوق ذلك كله رافع أول صرح حجرى فى التاريخ : هرم الملك " زوسر " المدرج بسقارة .
ويوم كانت الانسانية بعد فى طفولتها الأولى أهدتها مصر فى " أيمحوتب " عبقرية طبية , ويقول عنه " جيمس هنرى برستد " وكورت زيته " أنه المخترع الأول لفن الطب بلا منافس . عبد فى منف كإله للشفاء . وقال فيه " أوسلى " : أنه أول صورة لطبيب واقعى , واصبح إلهاً شعبياً محبوباً .
وبتزايد الكشوف الأثرية التى تركها على مر الزمن بزغت الأهمية الطبية والعلاجية للعديد من المواقع فى أرجاء مصر مثل حلوان والفيوم وجنوب سيناء وسفاجا لما تتمتع به هذه الاماكن من مياه معدنية ورمال وكثبان قادرة على علاج وشفاء العديد من الامراض المستعصية فى عالمنا اليوم مثل الامراض الجلدية والروماتزمية .
ولقد أدركت الدولة الأهمية الطبية والعلاجية لهذه الأماكن فقامت على رعايتها والاهتمام بها حيث صارت من أرقى أماكن الاستشفاء العالمية .
وهكذا أحتلت مصر موقعاً متميزاً على خريطة السياحة العلاجية واصبحت مقصداً لراغبى الاستشفاء من جميع انحاء العالم حيث يأتى اليها السائحون للأستمتاع بالمناخ الصحى والعلاج الطبى الطبيعى تحت رعاية أطباء متخصصين فى جميع الفروع والمستشفيات الحديثة التى يتوافر بها أحدث الاجهزة العالمية يساندهم أخصائيون فى التمرين والعلاج الطبيعى على أعلى مستوى من الخدمة .الى جانب تقديم برامج سياحية متنوعة لزيارة الاماكن السيحية الفريدة فى مصر.
الاستشفاء الطبيعى بمصر:
تنتشر فى مصر مئات من العيون والآبار الطبيعية ذات المياه المعدنية والكبريتية , تختلف فى العمق والسعة ودرجة الحرارة بين 30 , 73 درجة مئوية. وقد أثبتت التحليلات المعملية احتواء الكثير من هذه الينابيع الطبيعية على أعلى نسبة من عنصر الكبريت مقارنة بالأبار المنتشرة فى شتى أنحاء العالم كما تحتوى هذه المياه الطبيعية على عدة أملاح معدنية وبعض المعادن ذات القيمة العلاجية من أمثال كربونات الصوديوم ونسب متفاوتة من بعض العناصر الفلزية مثل الماغنسيوم والحديد .
كما أظهرت القياسات المعملية ملاءمة نسبة الملوحة فى هذه الموارد المائية الطبيعية للأغراض الاستشفائية ويضاف الى ذلك انتشار آبار المياه الطبيعية النقية الصالحة للشرب , والتى توسعت مصر فى استثمارها وإنتاجها على نحو إقتصادى فى السنوات الأخيرة فى إطار رقابة علمية صارمة على الجودة والمواصفات القياسية من حيث النقاء من الشوائب والطفيليات والجراثيم , ودرجة عسر الماء والتركيب الكيميائى , مما دفع بالعديد من الشركات الوطنية والأجنبية الكبرى الى التنافس للاستثمار فى هذا المجال .
ولم تكن رمال مصر أقل ثراء من مياها فقد أظهرت الدراسات احتواء الكثبان الرملية بالصحراء المصرية على نسب مأمونة وعظيمة الفائدة من العناصر المشعة , وقد أدى العلاج بطمر الجسم أو الوضع المؤلم منه بالرمال لفترات مدروسة ومحددة الى نتائج غير مسبوقة فى عدة أمراض روماتزمية مثل مرض الروماتويد والآلام الناجمة عن أمراض العمود الفقرى وغير ذلك من اسباب الألم الحاد والمزمن , مما يحار فيه الطب الحديث.
http://www.sis.gov.eg/Ar/Tourism/Types/Therapeutic/060204000000000001.htm#Hحلوان
http://www.sis.gov.eg/Ar/Tourism/Types/Therapeutic/060204000000000001.htm#Wالواحات البحرية
http://www.sis.gov.eg/Ar/Tourism/Types/Therapeutic/060204000000000001.htm#Sسيوة
http://www.sis.gov.eg/Ar/Tourism/Types/Therapeutic/060204000000000001.htm#El Wالوادى الجديد
http://www.sis.gov.eg/Ar/Tourism/Types/Therapeutic/060204000000000001.htm#Khargaالخارجة
الفرافرة
أسوان
الغردقة
http://www.sis.gov.eg/Ar/Tourism/Types/Therapeutic/060204000000000001.htm#Safagaسفاجا
سيناء
الخميس، 27 أغسطس 2009
Encyclopedia of Stress - Second Edition (REPOST)
Encyclopedia of Stress - Second Edition (REPOST
Summary:
Academic Press| ISBN:0120885034 | Edition 2007-05-18 | PDF | 3000 pages | 30 MB
Like the first edition, the second edition of the Encyclopedia of Stress covers nearly every conceivable aspect and ramification of stress including a wide range of related topics such as neuroimmune interactions, cytokines, enzymatic disorders, effects on the cardiovascular system, immunity and inflammation, and physical illnesses. Over the last decade, scientists have presented convincing research showing that psychological stress increases vulnerability to disease. They now understand more clearly that stress may be the thread tying together illnesses that were previously believed to be unrelated. Bone loss, increased abdominal fat, and damaged memory cells in the hippocampus have been linked to elevated cortisol levels. Building on the success of the first edition, this completely revised work surveys the vast amount of research generated in the past five years, resulting in a substantial revision with over 30% new material and over 100 new entries. Expanded sections include Animal Studies, Anxiety and Depression, Drugs, Depression, Disasters, and Psychological and Other Therapies. Also available online via ScienceDirect (2007) featuring extensive browsing, searching, and internal cross-referencing between articles in the work, plus dynamic linking to journal articles and abstract databases, making navigation flexible and easy. For more information, pricing options and availability visit www.info.sciencedirect.com. * Timely update on the topic of Post-Traumatic Stress Disorder taking into account events such as terrorism and middle east wars
* Includes expanded coverage on anxiety and depression
* Incorporates entries on the advances in our knowledge of immunology, cytokines and cell mediated immunity involved in stress responses and autoimmune diseases such as multiple sclerosis and Type I diabetes.
Academic Press| ISBN:0120885034 | Edition 2007-05-18 | PDF | 3000 pages | 30 MB
Like the first edition, the second edition of the Encyclopedia of Stress covers nearly every conceivable aspect and ramification of stress including a wide range of related topics such as neuroimmune interactions, cytokines, enzymatic disorders, effects on the cardiovascular system, immunity and inflammation, and physical illnesses. Over the last decade, scientists have presented convincing research showing that psychological stress increases vulnerability to disease. They now understand more clearly that stress may be the thread tying together illnesses that were previously believed to be unrelated. Bone loss, increased abdominal fat, and damaged memory cells in the hippocampus have been linked to elevated cortisol levels. Building on the success of the first edition, this completely revised work surveys the vast amount of research generated in the past five years, resulting in a substantial revision with over 30% new material and over 100 new entries. Expanded sections include Animal Studies, Anxiety and Depression, Drugs, Depression, Disasters, and Psychological and Other Therapies. Also available online via ScienceDirect (2007) featuring extensive browsing, searching, and internal cross-referencing between articles in the work, plus dynamic linking to journal articles and abstract databases, making navigation flexible and easy. For more information, pricing options and availability visit www.info.sciencedirect.com. * Timely update on the topic of Post-Traumatic Stress Disorder taking into account events such as terrorism and middle east wars
* Includes expanded coverage on anxiety and depression
* Incorporates entries on the advances in our knowledge of immunology, cytokines and cell mediated immunity involved in stress responses and autoimmune diseases such as multiple sclerosis and Type I diabetes.
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NMS Review for USMLE Step 2 CK 3rd Edition (National Medical Series for Independent Study)
NMS Review for USMLE Step 2 CK 3rd Edition (National Medical Series for Independent Study)
Summary:
By Kenneth Ibsen, Nandan Bhatt
Publisher: Lippincott Williams & Wilkins
Number Of Pages: 654
Publication Date: 2006-04-01
ISBN-10 / ASIN: 0781765226
ISBN-13 / EAN: 9780781765220
Product Description:
Throughout the past decade, NMS Review for USMLE Step 2 has served as an important adjunct for students preparing to take the USMLE Step 2 examination. This updated third edition targets the needs of medical students taking the CK (clinical knowledge) component of the Step 2 exam, making this text a necessary and useful tool. NMS Review for USMLE Step 2 CK continues the traditions of relevance and excellence established by the previous editions. This book will help students review all major content areas covered on the exam, become acquainted with the current exam format, and determine clinical areas where further study may be needed
.
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Step-Up to USMLE Step 2
Step-Up to USMLE Step 2
Summary:
Lippincott Williams & Wilkins | 2007-09-01 | ISBN: 0781771560 | 352 pages | CHM | 6,3 MB
This high-yield, systems-based review provides one-stop shopping for USMLE Step 2. The user-friendly outline format offers numerous tables, illustrations, and flow charts allowing the reader to focus on the most relevant facts for test day. Based on student feedback, the thoroughly updated Second Edition includes additional "Quick Hits" and "Next Steps" and new "Mnemonics" marginalia to speed and supplement learning in addition to new illustrations, expanded coverage of ARDS, a new table on breast malignancy variants, and updated vaccination schedules. Enjoy this great book!
Lippincott Williams & Wilkins | 2007-09-01 | ISBN: 0781771560 | 352 pages | CHM | 6,3 MB
This high-yield, systems-based review provides one-stop shopping for USMLE Step 2. The user-friendly outline format offers numerous tables, illustrations, and flow charts allowing the reader to focus on the most relevant facts for test day. Based on student feedback, the thoroughly updated Second Edition includes additional "Quick Hits" and "Next Steps" and new "Mnemonics" marginalia to speed and supplement learning in addition to new illustrations, expanded coverage of ARDS, a new table on breast malignancy variants, and updated vaccination schedules. Enjoy this great book!
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The Internal Medicine Casebook: Real Patients, Real Answers
The Internal Medicine Casebook: Real Patients, Real Answers Summary:
Publisher: Lippincott Williams & Wilkins | ISBN: 0781765293 | 2007-02-01 | PDF | 496 pages | 1.66 Mb
Developed by the internal medicine residency teaching staff at the University of Colorado, this book presents patient-oriented cases for 88 diseases in all areas of internal medicine. Case studies follow a question-and-answer format that mirrors rounds presentations. Each case study walks you through the workup and management of the problem and reviews the underlying pathophysiology. The book is an excellent review tool for resident in-service exams or American Board of Internal Medicine certification exams. This edition's questions and problems have been extensively rewritten to incorporate new diagnostic methods and treatments. Coverage of urology and hepatology has been expanded.
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الثلاثاء، 25 أغسطس 2009
First Aid Q&A for the USMLE Step 1, Second Edition
First Aid Q&A for the USMLE Step 1, Second Edition
Summary:
Publisher: McGraw-Hill Medical | Number Of Pages: 676 | Publication Date: 2009-01-23 | ISBN-10: 0071597948 | PDF | 5 Mb
The essential Q&A companion book to First Aid for the® USMLE Step 1
First Aid™ Q&A for the USMLE Step 1 features 1,000 board-style questions and answers, along with explanations for both correct and incorrect answers.
The content is keyed to First Aid for the® USMLE Step 1, allowing you to study high-yield facts and Q&As simultaneously. All questions have been reviewed by students who just aced the exam.
Publisher: McGraw-Hill Medical | Number Of Pages: 676 | Publication Date: 2009-01-23 | ISBN-10: 0071597948 | PDF | 5 Mb
The essential Q&A companion book to First Aid for the® USMLE Step 1
First Aid™ Q&A for the USMLE Step 1 features 1,000 board-style questions and answers, along with explanations for both correct and incorrect answers.
The content is keyed to First Aid for the® USMLE Step 1, allowing you to study high-yield facts and Q&As simultaneously. All questions have been reviewed by students who just aced the exam.
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or
==
Advances in Cancer Research, Volume 43
Advances in Cancer Research, Volume 43
Summary:
By Sidney Weinhouse, George Klein
Publisher: Academic Press
Number Of Pages: 321
Publication Date: 1985-02
ISBN-10 / ASIN: 0120066432
ISBN-13 / EAN: 9780120066438
By Sidney Weinhouse, George Klein
Publisher: Academic Press
Number Of Pages: 321
Publication Date: 1985-02
ISBN-10 / ASIN: 0120066432
ISBN-13 / EAN: 9780120066438
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=
Complications of Gynecologic Endoscopic Surgery
Complications of Gynecologic Endoscopic Surgery
Summary:
Saunders | 1 Edition | May 2006 | 0721606695 | 256 pages | PDF | 17.5 MB
Featuring the work of Dr. Isaacson – a recognized and respected member of the Ob/Gyn community – this new resource examines all aspects of complications that can potentially occur in gynecologic endoscopic surgery. It offers comprehensive coverage of the entire patient perioperative process, from choosing the appropriate patient to undergoing gynecologic endoscopic surgery...and every process in between. Each chapter has a consistent format touching on the prevention, recognition, and management of a specific complication, and starts with a review of the literature on the likelihood that a specific complication will occur. Abundant diagrams and photographs of complications and management enhance the material and illustrate and clarify the concepts presented. * Categorizes complications by damage to a specific organ system and not from a particular procedure. * Covers the prevention, recognition, and management of complications to the GI, GU, vascular organ systems as well as complications from infection, thermal injury and patient positioning. * Focuses on the recognition of specific complications to minimize patient morbidity and maximize early management. * Presents a consistent chapter organization throughout to facilitate quick access to guidance on specific complications. * Includes chapters on vascular, bowel, and ureter injuries – areas where most serious complications arise. * Offers a comprehensive review – written by two attorneys – of how to prevent a lawsuit and how to manage the process when a notice has been served.
Saunders | 1 Edition | May 2006 | 0721606695 | 256 pages | PDF | 17.5 MB
Featuring the work of Dr. Isaacson – a recognized and respected member of the Ob/Gyn community – this new resource examines all aspects of complications that can potentially occur in gynecologic endoscopic surgery. It offers comprehensive coverage of the entire patient perioperative process, from choosing the appropriate patient to undergoing gynecologic endoscopic surgery...and every process in between. Each chapter has a consistent format touching on the prevention, recognition, and management of a specific complication, and starts with a review of the literature on the likelihood that a specific complication will occur. Abundant diagrams and photographs of complications and management enhance the material and illustrate and clarify the concepts presented. * Categorizes complications by damage to a specific organ system and not from a particular procedure. * Covers the prevention, recognition, and management of complications to the GI, GU, vascular organ systems as well as complications from infection, thermal injury and patient positioning. * Focuses on the recognition of specific complications to minimize patient morbidity and maximize early management. * Presents a consistent chapter organization throughout to facilitate quick access to guidance on specific complications. * Includes chapters on vascular, bowel, and ureter injuries – areas where most serious complications arise. * Offers a comprehensive review – written by two attorneys – of how to prevent a lawsuit and how to manage the process when a notice has been served.
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The Encyclopedia of Arthritis
The Encyclopedia of Arthritis
Summary:
Facts on File | 2003 | ISBN: 081604810X | PDF | 384 pages | 1,4 MB
Arthritis is the number one cause of disability in the United States. More than 40 million people show some evidence of it on x-rays and more than 16 million suffer its effects. One of the most common misconceptions regarding arthritis is that it is a single disease, when in reality there are many different types of arthritis, requiring different types of treatment. The Encyclopedia of Arthritis is a new volume in the Library of Health and Living series. It provides comprehensive coverage of the topic in an accessible A-to-Z format written for lay reader but useful to the professional. The book covers everything from definitions of specific types of arthritis, its symptoms, its causes, and diagnoses to medications, pain management, and possible treatments. Relevant appendixes listing statistics and resources, information on drugs used for treatment, directories of organizations, periodicals and internet resources, and an extensive bibliography are also included.
Facts on File | 2003 | ISBN: 081604810X | PDF | 384 pages | 1,4 MB
Arthritis is the number one cause of disability in the United States. More than 40 million people show some evidence of it on x-rays and more than 16 million suffer its effects. One of the most common misconceptions regarding arthritis is that it is a single disease, when in reality there are many different types of arthritis, requiring different types of treatment. The Encyclopedia of Arthritis is a new volume in the Library of Health and Living series. It provides comprehensive coverage of the topic in an accessible A-to-Z format written for lay reader but useful to the professional. The book covers everything from definitions of specific types of arthritis, its symptoms, its causes, and diagnoses to medications, pain management, and possible treatments. Relevant appendixes listing statistics and resources, information on drugs used for treatment, directories of organizations, periodicals and internet resources, and an extensive bibliography are also included.
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Pervasive Healthcare Computing: EMR/EHR, Wireless and Health Monitoring (2009
Pervasive Healthcare Computing: EMR/EHR, Wireless and Health Monitoring (2009) Summary:
Publisher: Springer | Language: English | ISBN:1441902147 | 295 pages | Data: 2009 | PDF | 2 Mb
Description: Pervasive healthcare is the conceptual system of providing healthcare to anyone, at anytime, and anywhere by removing restraints of time and location while increasing both the coverage and the quality of healthcare. "Pervasive Healthcare Monitoring" is at the forefront of this research, and presents the ways in which mobile and wireless technologies can be used to implement the vision of pervasive healthcare. This vision includes prevention, healthcare maintenance and checkups; short-term monitoring (home healthcare monitoring), long-term monitoring (nursing home), and personalized healthcare monitoring; and incidence detection and management, emergency intervention, and transportation and treatment. The pervasive healthcare applications include pervasive health monitoring, intelligent emergency management system, pervasive healthcare data access, and ubiquitous mobile telemedicine. "Pervasive Healthcare Monitoring" fills the need for a research-oriented book on the wide array of emerging healthcare applications and services, including the treatment of several new wireless technologies and the ways in which they will implement the vision of pervasive healthcare. This book is written primarily for university faculty and graduate students in the field of healthcare technologies, and industry professionals involved in healthcare IT research, design, and development.
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Human Adult Stem Cells. . .Human Cell Culture
Human Adult Stem Cells (Human Cell Culture) Summary:
By John R. Masters, Bernhard Ø. Palsson
Publisher: Springer
Number Of Pages: 212
Publication Date: 2009-06-01
ISBN-10 / ASIN: 9048122686
ISBN-13 / EAN: 9789048122684
Product Description:
The aim of volume 7 of Human Cell Culture is to provide clear and precise methods for growing primary cultures of adult stem cells from various human tissues and describe culture conditions in which these adult stem cells differentiate along their respective lineages. The book will be of value to biomedical scientists and of special interest to stem cell biologists and tissue engineers. Each chapter is written by experts actively involved in growing human adult stem cells.
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الاثنين، 24 أغسطس 2009
Encyclopedia of Multicultural Psychology
Yo Jackson, «Encyclopedia of Multicultural Psychology»
Sage Publications, Inc | ISBN 1412909481 | 2006-08-18 | PDF | 2.6 Mb | 536 pages
Sage Publications, Inc | ISBN 1412909481 | 2006-08-18 | PDF | 2.6 Mb | 536 pages
The Encyclopedia of Multicultural Psychology is the first authoritative guide to synthesize the dynamic field of multicultural psychology. This volume includes entries on a broad array of issues and covers the breadth of psychology viewed through the lens of the racial and ethnic minority experience. The Encyclopedia addresses culture across a broad spectrum of psychological perspectives and includes topics that are relevant to social psychology, cognitive psychology, environmental psychology, cross-cultural psychology, and clinical psychology
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http://mihd.net/v0jyo1
or
Behaving Badly: Aversive Behaviors in Interpersonal Relationships
Behaving Badly: Aversive Behaviors in Interpersonal Relationships
Publisher: American Psychological Association | ISBN: 1557987165 | edition 2000 | PDF | 333 pages | 17 mb
Explores aversive behaviors -- such as gossiping, betrayal, and insens itivity -- that lead to so much dissatisfaction in our most intimate r elationships
Publisher: American Psychological Association | ISBN: 1557987165 | edition 2000 | PDF | 333 pages | 17 mb
Explores aversive behaviors -- such as gossiping, betrayal, and insens itivity -- that lead to so much dissatisfaction in our most intimate r elationships
download link
or
Jerald Kay, Allan Tasman - Essentials of Psychiatry
Jerald Kay, Allan Tasman - Essentials of Psychiatry
Wiley | ISBN: 0470018545 | 30/08/2006 | English | 1092 pages | PDF (OCR!) | 20 MB
Wiley | ISBN: 0470018545 | 30/08/2006 | English | 1092 pages | PDF (OCR!) | 20 MB
Essentials of Psychiatry provides a synopsis of the most critical material in the field of psychiatry. It covers the whole field, including assessment of the patient, definitions of each disorder, all treatment options and prognosis. The phenomenological classification of disorders is based on the APA’s DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders. This is followed by full treatment plans for each condition and a review of each therapy option in a dedicated therapeutics section
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or
"Yoga for Diabetes", 2008
Yoga for Diabetes", 2008
"Yoga for Diabetes", 2008
English | mpg | 848 x 448 | DVD Rip | 128kbps vbr mp3 | 25 fps
English | mpg | 848 x 448 | DVD Rip | 128kbps vbr mp3 | 25 fps
Yoga to reduce Obesity
Pain Prevention: Increased flexibility and strength can help prevent the causes of some types of back pain. Many people who suffer from back pain spend a lot of time sitting at a computer or driving a car. That can cause tightness and spinal compression, which you can begin to address with yoga. Yoga also improves your alignment, both in and out of class, which helps prevent many other types of pain.
Better Breathing: Most of us breathe very shallowly into the lungs and don't give much thought to how we breathe. Yoga breathing exercises, called Pranayama, focus the attention on the breath and teach us how to better use our lungs, which benefits the entire body. Certain types of breath can also help clear the nasal passages and even calm the central nervous system, which has both physical and mental benefits.
Pain Prevention: Increased flexibility and strength can help prevent the causes of some types of back pain. Many people who suffer from back pain spend a lot of time sitting at a computer or driving a car. That can cause tightness and spinal compression, which you can begin to address with yoga. Yoga also improves your alignment, both in and out of class, which helps prevent many other types of pain.
Better Breathing: Most of us breathe very shallowly into the lungs and don't give much thought to how we breathe. Yoga breathing exercises, called Pranayama, focus the attention on the breath and teach us how to better use our lungs, which benefits the entire body. Certain types of breath can also help clear the nasal passages and even calm the central nervous system, which has both physical and mental benefits.
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Worterbuch der Psychotherapie
Worterbuch der Psychotherapie
Gerhard Stumm, Alfred Pritz - Worterbuch der Psychotherapie. Title: Worterbuch der Psychotherapie.
Springer | 2007 | ISBN: 3211832483 | 854 pages | PDF | 2.3 MB
Springer | 2007 | ISBN: 3211832483 | 854 pages | PDF | 2.3 MB
Erstmals im deutschen Sprachraum wird mit diesem Wörterbuch das gesamte Gebiet der Psychotherapie anhand von 1350 Stichworten in alphabetischer Reihenfolge beschrieben (bis zu einer Seite pro Stichwort!). Rund 300 Autoren aus 50 Fachbereichen haben sich an diesem einzigartigen Lexikon beteiligt. Die Begriffe sind mit Querverweisen vernetzt, unter Bezugnahme auf den jeweiligen Fachbereich herausgearbeitet und differenziert. Etwa 6000 Quellenangaben leiten weiter zu den einzelnen Stichworten und vertiefender Literatur
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.
Encyclopedia of Global Health
"Encyclopedia of Global Health" ed. by Yawei Zhang
Sage Publications, Inc | 2008 | ISBN: 1412941865 | 2046 pages | PDF | 23 Mb
Sage Publications, Inc | 2008 | ISBN: 1412941865 | 2046 pages | PDF | 23 Mb
A general reference for topics related to health worlwide, this encyclopedia is ambitious in its scope, with entries for specific diseases and conditions, geographical areas, health issues, biographical information, and organizations related to world health policy. This book includes 1200 entries from "Abortion" to "Zoll. An alphabetical contents list is included in each volume. The thorough entries vary in length, and each one concludes with a bibliography and cross-references
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An Anatomy of Thought: The Origin and Machinery of the Mind
An Anatomy of Thought: The Origin and Machinery of the Mind
Posted By : Book-er
Posted By : Book-er
Ian Glynn "An Anatomy of Thought: The Origin and Machinery of the Mind"
Oxford University Press | English | 2003-04-10 | ISBN: 0195158032 | 464 pages | PDF | 25 MB
Drawing on a dazzling array of disciplines--physiology, neurology, psychology, anthropology, linguistics, and philosophy--Ian Glynn explains virtually every aspect of the workings of the brain, unlocking the mysteries of the mind. Glynn writes with exceptional clarity as he illuminates the mechanics of nerve messages; the functioning of sensory receptors; the processes by which the brain sees, tastes, and smells; the seats of language, memory, and emotions. The breadth of Glynn's erudition is astonishing, as he ranges from parallel processing in computers to the specialization of different regions of the brain (illustrated with fascinating instances of the bizarre effects of localized brain damage). He explains the different types of memory, traces the path of information that leads to emotional responses, and engages in a discussion of language that ranges from Noam Chomsky to Hawaiian pidgin. No other single volume has captured the full expanse of our knowledge of consciousness and the brain. A work of unequaled authority and eloquence, this book promises to be a new landmark of scientific writing. "Monumental."--The Observer "Glynn's erudition is astonishing...a hugely enjoyable intellectual journey."--Nature
Oxford University Press | English | 2003-04-10 | ISBN: 0195158032 | 464 pages | PDF | 25 MB
Drawing on a dazzling array of disciplines--physiology, neurology, psychology, anthropology, linguistics, and philosophy--Ian Glynn explains virtually every aspect of the workings of the brain, unlocking the mysteries of the mind. Glynn writes with exceptional clarity as he illuminates the mechanics of nerve messages; the functioning of sensory receptors; the processes by which the brain sees, tastes, and smells; the seats of language, memory, and emotions. The breadth of Glynn's erudition is astonishing, as he ranges from parallel processing in computers to the specialization of different regions of the brain (illustrated with fascinating instances of the bizarre effects of localized brain damage). He explains the different types of memory, traces the path of information that leads to emotional responses, and engages in a discussion of language that ranges from Noam Chomsky to Hawaiian pidgin. No other single volume has captured the full expanse of our knowledge of consciousness and the brain. A work of unequaled authority and eloquence, this book promises to be a new landmark of scientific writing. "Monumental."--The Observer "Glynn's erudition is astonishing...a hugely enjoyable intellectual journey."--Nature
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الجمعة، 21 أغسطس 2009
Drug-Induced Hepatotoxicity
Drugs are an important cause of liver injury. More than 900 drugs, toxins, and herbs have been reported to cause liver injury, and drugs account for 20-40% of all instances of fulminant hepatic failure. Approximately 75% of the idiosyncratic drug reactions result in liver transplantation or death. Drug-induced hepatic injury is the most common reason cited for withdrawal of an approved drug. Physicians must be vigilant in identifying drug-related liver injury because early detection can decrease the severity of hepatotoxicity if the drug is discontinued. The manifestations of drug-induced hepatotoxicity are highly variable, ranging from asymptomatic elevation of liver enzymes to fulminant hepatic failure. Knowledge of the commonly implicated agents and a high index of suspicion are essential in diagnosis.
For excellent patient education resources, visit eMedicine's Poisoning Center, Public Health Center, and Substance Abuse Center. Also, see eMedicine's patient education articles Acetaminophen (Tylenol) Poisoning, FDA Overview, Pain Medications, and Alcoholism.
Mortality/morbidity
In the United States, approximately 2000 cases of acute liver failure occur annually and drugs account for over 50% of them (39% are due to acetaminophen, 13% are idiosyncratic reactions due to other medications). Drugs account for 2-5% of cases of patients hospitalized with jaundice and approximately 10% of all cases of acute hepatitis.
Internationally, data on the incidence of adverse hepatic drug reactions in the general population remain unknown.
Drugs withdrawn from the market secondary to hepatotoxicity
In the last few years, the US Food and Drug Administration (FDA) has withdrawn 2 drugs from the market for causing severe liver injury: bromfenac and troglitazone. Bromfenac (Duract), a nonsteroidal anti-inflammatory drug (NSAID), was introduced in 1997 as a short-term analgesic for orthopedic patients. Although approved for a dosing period of less than 10 days, patients used it for longer periods. This resulted in more than 50 cases of severe hepatic injury, and the drug had to be withdrawn in 1998. Troglitazone (Rezulin) is a thiazolidinedione and was approved in 1997 as an antidiabetic agent. Over 3 years, more than 90 cases of hepatotoxicity were reported, which resulted in withdrawal of this drug.
Kava kava, an herb used for anxiety, was reported as being hepatotoxic and was withdrawn from the German market.1 The FDA has also issued a warning in this country. This demonstrates the importance of postmarketing surveillance to identify reactions that are not reported or are underreported in drug trials.
Pemoline (Cylert), used for attention deficit disorder and narcolepsy is no longer available in the United States. The Food and Drug Administration (FDA) concluded that the overall risk of liver toxicity from pemoline outweighs the benefits. In May 2005, Abbott chose to stop sales and marketing of their brand of pemoline (Cylert) in the U.S. In October 2005, all companies that produced generic versions of pemoline also agreed to stop sales and marketing of pemoline.
Other drugs that have significant limitations of use because of their hepatotoxic effects are felbamate (Felbatol), an antiepileptic used for complex partial seizures; zileuton (Zyflo), indicated for asthma; tolcapone (Tasmar), used for Parkinson disease; trovafloxacin (Trovan), an antibiotic; benoxaprofen, an NSAID; and tienilic acid, a diuretic.
Recent warnings issued by the FDA
In June 2009, the US Food and Drug Administration (FDA) issued a report that identified 32 cases (22 adult and 10 pediatric) of serious liver injury associated with propylthiouracil (PTU). Of the adults, 12 deaths and 5 liver transplants occurred, and among the pediatric patients, 1 death and 6 liver transplants occurred. PTU is indicated for hyperthyroidism due to Graves disease.
These reports suggest an increased risk for liver toxicity with PTU compared with methimazole. Serious liver injury has been identified with methimazole in 5 cases (3 resulting in death). PTU is considered as second-line drug therapy, except in patients who are allergic or intolerant to methimazole, or for women who are in the first trimester of pregnancy. Rare cases of embryopathy, including aplasia cutis, have been reported with methimazole during pregnancy.
The FDA recommends the following criteria be considered for prescribing PTU. For more information see the FDA Safety Alert.
Reserve PTU use during first trimester of pregnancy, or in patients who are allergic to or intolerant of methimazole.
Closely monitor PTU therapy for signs and symptoms of liver injury, especially during the first 6 months after initiation of therapy.
For suspected liver injury, promptly discontinue PTU therapy and evaluate for evidence of liver injury and provide supportive care.
PTU should not be used in pediatric patients unless the patient is allergic to or intolerant of methimazole, and no other treatment options are available.
Counsel patients to promptly contact their health care provider for the following signs or symptoms: fatigue, weakness, vague abdominal pain, loss of appetite, itching, easy bruising, or yellowing of the eyes or skin.
Severe hepatic injury, including cases of hepatic failure, has been reported in patients taking interferon beta-1a (Avonex) used in treatment of multiple sclerosis. Asymptomatic elevation of hepatic transaminases have also been reported and, in some patients, recurred upon rechallenge. In some cases, these events occurred in the presence of other drugs that have been associated with hepatic injury. The potential risk of Avonex used in combination with known hepatotoxic drugs or other products (eg, alcohol) should be considered prior to Avonex administration or when adding new agents to the regimen of patients already on Avonex.
In January 2006, the US Food and Drug Administration (FDA) issued a warning after 3 cases of serious liver toxicity were reported with taking telithromycin. In June 2006, the prescribing information for telithromycin (Ketek) was changed to include a warning describing the drug's association with rare cases of serious liver injury and liver failure. Four of these events resulted in deaths and one resulted in liver transplant. The added warning follows evaluation by the FDA on postmarketing surveillance reports. If clinical hepatitis or liver enzyme elevations combined with other systemic symptoms occur, telithromycin should be permanently discontinued. Telithromycin is an antibiotic of the ketolide class, approved by the FDA in April 2004 for the treatment of respiratory infections in adults. It is marketed and is widely used in several countries including Japan and countries in Europe.
In February 2007, the FDA took further action and removed 2 of the 3 indications: acute bacterial sinusitis and acute bacterial exacerbations of chronic bronchitis. Following comprehensive scientific analysis, the FDA determined that the balance of benefits and risks no longer supports the approval of the drug for these indications. Telithromycin is now indicated for treatment of mild-to-moderate community-acquired pneumonia.
In October 2005, the manufactures of duloxetine (an anti-depressant) reported postmarketing cases of hepatitis and cholestatic jaundice. The new package insert now states, "Cymbalta should not be administered to patients with substantial alcohol use or any hepatic insufficiency."
Risk factors for drug-induced liver injury
Race: Some drugs appear to have different toxicities based on race. For example, blacks and Hispanics may be more susceptible to isoniazid (INH) toxicity. The rate of metabolism is under the control of P-450 enzymes and can vary from individual to individual.
Age: Apart from accidental exposure, hepatic drug reactions are rare in children. Elderly persons are at increased risk of hepatic injury because of decreased clearance, drug-to-drug interactions, reduced hepatic blood flow, variation in drug binding, and lower hepatic volume. In addition, poor diet, infections, and multiple hospitalizations are important reasons for drug-induced hepatotoxicity.
Sex: Although the reasons are unknown, hepatic drug reactions are more common in females.
Alcohol ingestion: Alcoholic persons are susceptible to drug toxicity because alcohol induces liver injury and cirrhotic changes that alter drug metabolism. Alcohol causes depletion of glutathione (hepatoprotective) stores that make the person more susceptible to toxicity by drugs.
Liver disease: In general, patients with chronic liver disease are not uniformly at increased risk of hepatic injury. Although the total cytochrome P-450 is reduced, some may be affected more than others. The modification of doses in persons with liver disease should be based on the knowledge of the specific enzyme involved in the metabolism. Patients with HIV infection who are co-infected with hepatitis B or C virus are at increased risk for hepatotoxic effects when treated with antiretroviral therapy. Similarly, patients with cirrhosis are at increased risk of decompensation by toxic drugs.
Genetic factors: A unique gene encodes each P-450 protein. Genetic differences in the P-450 enzymes can result in abnormal reactions to drugs, including idiosyncratic reactions. Debrisoquine is an antiarrhythmic drug that undergoes poor metabolism because of abnormal expression of P-450-II-D6. This can be identified by polymerase chain reaction amplification of mutant genes. This has led to the possibility of future detection of persons who can have abnormal reactions to a drug.
Other comorbidities: Persons with AIDS, persons who are malnourished, and persons who are fasting may be susceptible to drug reactions because of low glutathione stores.
Drug formulation: Long-acting drugs may cause more injury than shorter-acting drugs.
Host factors that may enhance susceptibility to drugs, possibly inducing liver disease
Female - Halothane, nitrofurantoin, sulindac
Male - Amoxicillin-clavulanic acid (Augmentin)
Old age - Acetaminophen, halothane, INH, amoxicillin-clavulanic acid
Young age - Salicylates, valproic acid
Fasting or malnutrition - Acetaminophen
Large body mass index/obesity - Halothane
Diabetes mellitus - Methotrexate, niacin
Renal failure - Tetracycline, allopurinol
AIDS - Dapsone, trimethoprim-sulfamethoxazole
Hepatitis C - Ibuprofen, ritonavir, flutamide
Preexisting liver disease - Niacin, tetracycline, methotrexate
Pathophysiology and mechanisms of drug-induced liver injury
Pathophysiologic mechanisms: The pathophysiologic mechanisms of hepatotoxicity are still being explored and include both hepatocellular and extracellular mechanisms. The following are some of the mechanisms that have been described:
Disruption of the hepatocyte: Covalent binding of the drug to intracellular proteins can cause a decrease in ATP levels, leading to actin disruption. Disassembly of actin fibrils at the surface of the hepatocyte causes blebs and rupture of the membrane.
Disruption of the transport proteins: Drugs that affect transport proteins at the canalicular membrane can interrupt bile flow. Loss of villous processes and interruption of transport pumps such as multidrug resistance–associated protein 3 prevent the excretion of bilirubin, causing cholestasis.
Cytolytic T-cell activation: Covalent binding of a drug to the P-450 enzyme acts as an immunogen, activating T cells and cytokines and stimulating a multifaceted immune response.
Apoptosis of hepatocytes: Activation of the apoptotic pathways by the tumor necrosis factor-alpha receptor of Fas may trigger the cascade of intercellular caspases, which results in programmed cell death.
Mitochondrial disruption: Certain drugs inhibit mitochondrial function by a dual effect on both beta-oxidation energy production by inhibiting the synthesis of nicotinamide adenine dinucleotide and flavin adenine dinucleotide, resulting in decreased ATP production.
Bile duct injury: Toxic metabolites excreted in bile may cause injury to the bile duct epithelium.
Drug toxicity mechanisms: The classic division of drug reactions is into at least 2 major groups, (1) drugs that directly affect the liver and (2) drugs that mediate an immune response.
Intrinsic or predictable drug reactions: Drugs that fall into this category cause reproducible injuries in animals, and the injury is dose related. The injury can be due to the drug itself or to a metabolite. Acetaminophen is a classic example of a known intrinsic or predictable hepatotoxin at supertherapeutic doses. Another classic example is carbon tetrachloride.
Idiosyncratic drug reactions: Idiosyncratic drug reactions can be subdivided into those that are classified as hypersensitivity or immunoallergic and those that are metabolic-idiosyncratic.
Hypersensitivity: Phenytoin is a classic, if not common, cause of hypersensitivity reactions. The response is characterized by fever, rash, and eosinophilia and is an immune-related response with a typical short latency period of 1-4 weeks.
Metabolic-idiosyncratic: This type of reaction occurs through an indirect metabolite of the offending drug. Unlike intrinsic hepatotoxins, the response rate is variable and can occur within a week or up to one year later. It occurs in a minority of patients taking the drug, and no clinical manifestations of hypersensitivity are noted. INH toxicity is considered to fall into this class. Not all drugs fall neatly into one of these categories, and overlapping mechanisms may occur with some drugs (eg, halothane).
For excellent patient education resources, visit eMedicine's Poisoning Center, Public Health Center, and Substance Abuse Center. Also, see eMedicine's patient education articles Acetaminophen (Tylenol) Poisoning, FDA Overview, Pain Medications, and Alcoholism.
Mortality/morbidity
In the United States, approximately 2000 cases of acute liver failure occur annually and drugs account for over 50% of them (39% are due to acetaminophen, 13% are idiosyncratic reactions due to other medications). Drugs account for 2-5% of cases of patients hospitalized with jaundice and approximately 10% of all cases of acute hepatitis.
Internationally, data on the incidence of adverse hepatic drug reactions in the general population remain unknown.
Drugs withdrawn from the market secondary to hepatotoxicity
In the last few years, the US Food and Drug Administration (FDA) has withdrawn 2 drugs from the market for causing severe liver injury: bromfenac and troglitazone. Bromfenac (Duract), a nonsteroidal anti-inflammatory drug (NSAID), was introduced in 1997 as a short-term analgesic for orthopedic patients. Although approved for a dosing period of less than 10 days, patients used it for longer periods. This resulted in more than 50 cases of severe hepatic injury, and the drug had to be withdrawn in 1998. Troglitazone (Rezulin) is a thiazolidinedione and was approved in 1997 as an antidiabetic agent. Over 3 years, more than 90 cases of hepatotoxicity were reported, which resulted in withdrawal of this drug.
Kava kava, an herb used for anxiety, was reported as being hepatotoxic and was withdrawn from the German market.1 The FDA has also issued a warning in this country. This demonstrates the importance of postmarketing surveillance to identify reactions that are not reported or are underreported in drug trials.
Pemoline (Cylert), used for attention deficit disorder and narcolepsy is no longer available in the United States. The Food and Drug Administration (FDA) concluded that the overall risk of liver toxicity from pemoline outweighs the benefits. In May 2005, Abbott chose to stop sales and marketing of their brand of pemoline (Cylert) in the U.S. In October 2005, all companies that produced generic versions of pemoline also agreed to stop sales and marketing of pemoline.
Other drugs that have significant limitations of use because of their hepatotoxic effects are felbamate (Felbatol), an antiepileptic used for complex partial seizures; zileuton (Zyflo), indicated for asthma; tolcapone (Tasmar), used for Parkinson disease; trovafloxacin (Trovan), an antibiotic; benoxaprofen, an NSAID; and tienilic acid, a diuretic.
Recent warnings issued by the FDA
In June 2009, the US Food and Drug Administration (FDA) issued a report that identified 32 cases (22 adult and 10 pediatric) of serious liver injury associated with propylthiouracil (PTU). Of the adults, 12 deaths and 5 liver transplants occurred, and among the pediatric patients, 1 death and 6 liver transplants occurred. PTU is indicated for hyperthyroidism due to Graves disease.
These reports suggest an increased risk for liver toxicity with PTU compared with methimazole. Serious liver injury has been identified with methimazole in 5 cases (3 resulting in death). PTU is considered as second-line drug therapy, except in patients who are allergic or intolerant to methimazole, or for women who are in the first trimester of pregnancy. Rare cases of embryopathy, including aplasia cutis, have been reported with methimazole during pregnancy.
The FDA recommends the following criteria be considered for prescribing PTU. For more information see the FDA Safety Alert.
Reserve PTU use during first trimester of pregnancy, or in patients who are allergic to or intolerant of methimazole.
Closely monitor PTU therapy for signs and symptoms of liver injury, especially during the first 6 months after initiation of therapy.
For suspected liver injury, promptly discontinue PTU therapy and evaluate for evidence of liver injury and provide supportive care.
PTU should not be used in pediatric patients unless the patient is allergic to or intolerant of methimazole, and no other treatment options are available.
Counsel patients to promptly contact their health care provider for the following signs or symptoms: fatigue, weakness, vague abdominal pain, loss of appetite, itching, easy bruising, or yellowing of the eyes or skin.
Severe hepatic injury, including cases of hepatic failure, has been reported in patients taking interferon beta-1a (Avonex) used in treatment of multiple sclerosis. Asymptomatic elevation of hepatic transaminases have also been reported and, in some patients, recurred upon rechallenge. In some cases, these events occurred in the presence of other drugs that have been associated with hepatic injury. The potential risk of Avonex used in combination with known hepatotoxic drugs or other products (eg, alcohol) should be considered prior to Avonex administration or when adding new agents to the regimen of patients already on Avonex.
In January 2006, the US Food and Drug Administration (FDA) issued a warning after 3 cases of serious liver toxicity were reported with taking telithromycin. In June 2006, the prescribing information for telithromycin (Ketek) was changed to include a warning describing the drug's association with rare cases of serious liver injury and liver failure. Four of these events resulted in deaths and one resulted in liver transplant. The added warning follows evaluation by the FDA on postmarketing surveillance reports. If clinical hepatitis or liver enzyme elevations combined with other systemic symptoms occur, telithromycin should be permanently discontinued. Telithromycin is an antibiotic of the ketolide class, approved by the FDA in April 2004 for the treatment of respiratory infections in adults. It is marketed and is widely used in several countries including Japan and countries in Europe.
In February 2007, the FDA took further action and removed 2 of the 3 indications: acute bacterial sinusitis and acute bacterial exacerbations of chronic bronchitis. Following comprehensive scientific analysis, the FDA determined that the balance of benefits and risks no longer supports the approval of the drug for these indications. Telithromycin is now indicated for treatment of mild-to-moderate community-acquired pneumonia.
In October 2005, the manufactures of duloxetine (an anti-depressant) reported postmarketing cases of hepatitis and cholestatic jaundice. The new package insert now states, "Cymbalta should not be administered to patients with substantial alcohol use or any hepatic insufficiency."
Risk factors for drug-induced liver injury
Race: Some drugs appear to have different toxicities based on race. For example, blacks and Hispanics may be more susceptible to isoniazid (INH) toxicity. The rate of metabolism is under the control of P-450 enzymes and can vary from individual to individual.
Age: Apart from accidental exposure, hepatic drug reactions are rare in children. Elderly persons are at increased risk of hepatic injury because of decreased clearance, drug-to-drug interactions, reduced hepatic blood flow, variation in drug binding, and lower hepatic volume. In addition, poor diet, infections, and multiple hospitalizations are important reasons for drug-induced hepatotoxicity.
Sex: Although the reasons are unknown, hepatic drug reactions are more common in females.
Alcohol ingestion: Alcoholic persons are susceptible to drug toxicity because alcohol induces liver injury and cirrhotic changes that alter drug metabolism. Alcohol causes depletion of glutathione (hepatoprotective) stores that make the person more susceptible to toxicity by drugs.
Liver disease: In general, patients with chronic liver disease are not uniformly at increased risk of hepatic injury. Although the total cytochrome P-450 is reduced, some may be affected more than others. The modification of doses in persons with liver disease should be based on the knowledge of the specific enzyme involved in the metabolism. Patients with HIV infection who are co-infected with hepatitis B or C virus are at increased risk for hepatotoxic effects when treated with antiretroviral therapy. Similarly, patients with cirrhosis are at increased risk of decompensation by toxic drugs.
Genetic factors: A unique gene encodes each P-450 protein. Genetic differences in the P-450 enzymes can result in abnormal reactions to drugs, including idiosyncratic reactions. Debrisoquine is an antiarrhythmic drug that undergoes poor metabolism because of abnormal expression of P-450-II-D6. This can be identified by polymerase chain reaction amplification of mutant genes. This has led to the possibility of future detection of persons who can have abnormal reactions to a drug.
Other comorbidities: Persons with AIDS, persons who are malnourished, and persons who are fasting may be susceptible to drug reactions because of low glutathione stores.
Drug formulation: Long-acting drugs may cause more injury than shorter-acting drugs.
Host factors that may enhance susceptibility to drugs, possibly inducing liver disease
Female - Halothane, nitrofurantoin, sulindac
Male - Amoxicillin-clavulanic acid (Augmentin)
Old age - Acetaminophen, halothane, INH, amoxicillin-clavulanic acid
Young age - Salicylates, valproic acid
Fasting or malnutrition - Acetaminophen
Large body mass index/obesity - Halothane
Diabetes mellitus - Methotrexate, niacin
Renal failure - Tetracycline, allopurinol
AIDS - Dapsone, trimethoprim-sulfamethoxazole
Hepatitis C - Ibuprofen, ritonavir, flutamide
Preexisting liver disease - Niacin, tetracycline, methotrexate
Pathophysiology and mechanisms of drug-induced liver injury
Pathophysiologic mechanisms: The pathophysiologic mechanisms of hepatotoxicity are still being explored and include both hepatocellular and extracellular mechanisms. The following are some of the mechanisms that have been described:
Disruption of the hepatocyte: Covalent binding of the drug to intracellular proteins can cause a decrease in ATP levels, leading to actin disruption. Disassembly of actin fibrils at the surface of the hepatocyte causes blebs and rupture of the membrane.
Disruption of the transport proteins: Drugs that affect transport proteins at the canalicular membrane can interrupt bile flow. Loss of villous processes and interruption of transport pumps such as multidrug resistance–associated protein 3 prevent the excretion of bilirubin, causing cholestasis.
Cytolytic T-cell activation: Covalent binding of a drug to the P-450 enzyme acts as an immunogen, activating T cells and cytokines and stimulating a multifaceted immune response.
Apoptosis of hepatocytes: Activation of the apoptotic pathways by the tumor necrosis factor-alpha receptor of Fas may trigger the cascade of intercellular caspases, which results in programmed cell death.
Mitochondrial disruption: Certain drugs inhibit mitochondrial function by a dual effect on both beta-oxidation energy production by inhibiting the synthesis of nicotinamide adenine dinucleotide and flavin adenine dinucleotide, resulting in decreased ATP production.
Bile duct injury: Toxic metabolites excreted in bile may cause injury to the bile duct epithelium.
Drug toxicity mechanisms: The classic division of drug reactions is into at least 2 major groups, (1) drugs that directly affect the liver and (2) drugs that mediate an immune response.
Intrinsic or predictable drug reactions: Drugs that fall into this category cause reproducible injuries in animals, and the injury is dose related. The injury can be due to the drug itself or to a metabolite. Acetaminophen is a classic example of a known intrinsic or predictable hepatotoxin at supertherapeutic doses. Another classic example is carbon tetrachloride.
Idiosyncratic drug reactions: Idiosyncratic drug reactions can be subdivided into those that are classified as hypersensitivity or immunoallergic and those that are metabolic-idiosyncratic.
Hypersensitivity: Phenytoin is a classic, if not common, cause of hypersensitivity reactions. The response is characterized by fever, rash, and eosinophilia and is an immune-related response with a typical short latency period of 1-4 weeks.
Metabolic-idiosyncratic: This type of reaction occurs through an indirect metabolite of the offending drug. Unlike intrinsic hepatotoxins, the response rate is variable and can occur within a week or up to one year later. It occurs in a minority of patients taking the drug, and no clinical manifestations of hypersensitivity are noted. INH toxicity is considered to fall into this class. Not all drugs fall neatly into one of these categories, and overlapping mechanisms may occur with some drugs (eg, halothane).
Anatomy of The Liver
The Couinaud classification of liver anatomy divides the liver into eight functionally indepedent segments.
Each segment has its own vascular inflow, outflow and biliary drainage.
In the centre of each segment there is a branch of the portal vein, hepatic artery and bile duct.
In the periphery of each segment there is vascular outflow through the hepatic veins.
Right hepatic vein divides the right lobe into anterior and posterior segments.
Middle hepatic vein divides the liver into right and left lobes (or right and left hemiliver). This plane runs from the inferior vena cava to the gallbladder fossa.
Left hepatic vein divides the left lobe into a medial and lateral part.
Portal vein divides the liver into upper and lower segments.
The left and right portal veins branch superiorly and inferiorly to project into the center of each segment.
Because of this division into self-contained units, each segment can be resected without damaging those remaining. For the liver to remain viable, resections must proceed along the vessels that define the peripheries of these segments. This means, that resection-lines parallel the hepatic veins,
The centrally located portal veins, bile ducts, and hepatic arteries are preserved.
Clockwise numbering of the segments Segments numbering
There are eight liver segments.
Segment 4 is sometimes divided into segment 4a and 4b according to Bismuth.
The numbering of the segments is in a clockwise manner (figure).
Segment 1 (caudate lobe) is located posteriorly. It is not visible on a frontal view.
On a frontal view of the liver the posteriorly located segments 6 and 7 are not visible.
The illustrations above are schematic presentations of the liversegments.
In reality however the proportions are different.
On a normal frontal view the segments 6 and 7 are not visible because they are located more posteriorly.
The right border of the liver is formed by segment 5 and 8.
Although segment 4 is part of the left hemiliver, it is situated more to the right.
Couinaud divided the liver into a functional left and right liver (in French 'gauche et droite foie') by a main portal scissurae containing the middle hepatic vein. This is known as Cantlie's line.
Cantlie's line runs from the middle of the gallbladder fossa anteriorly to the inferior vena cava posteriorly.
On this illustration it looks as if the medial part of the left lobe is separated from the lateral part by the falciform ligament. However it actually is the left hepatic vein, that separates the medial part (segment 4) from the lateral part (segments 2 and 3).
The left hepatic vein is located slightly to the left of the falciform ligament.
LEFT: above the level of the left portal vein.
RIGHT: at the level of the left portal vein Transverse anatomy
The far left figure is a transverse image through the superior liver segments, that are divided by the hepatic veins.
The right figure shows a transverse image at the level of the left portal vein.
At this level the left portal vein divides the left lobe of the liver into the superior segments (2 and 4A) and the inferior segments (3 and 4B).
The left portal vein is at a higher level than the right portal vein.
LEFT: at the level of the right portal vein.
RIGHT: at the level of the splenic vein.
The image on the far left is at the level of the right portal vein. At this level the right portal vein divides the right lobe of the liver into superior segments (7 and 8) and the inferior segments (5 and 6).
The level of the right portal vein is inferior to the level of the left portal vein.
At the level of the splenic vein, which is below the level of the right portal vein, only the inferior segments are seen (right image).
Hypertrophy of caudate lobe in a patient with livercirrhosis. Notice the small lobulated right hemiliver. Caudate lobe
The caudate lobe or segment 1 is located posteriorly.
The caudate lobe is anatomically different from other lobes in that it often has direct connections to the IVC through hepatic veins, that are separate from the main hepatic veins.
The caudate lobe may be supplied by both right and left branches of the portal vein.
On the left a patient with cirrhosis with extreme atrophy of the right lobe, normal volume of the left lobe and hypertrophy of the caudate lobe.
Due to a different blood supply the caudate lobe is spared from the disease process and hypertrophied to compensate for the loss of normal liverparenchyma
Each segment has its own vascular inflow, outflow and biliary drainage.
In the centre of each segment there is a branch of the portal vein, hepatic artery and bile duct.
In the periphery of each segment there is vascular outflow through the hepatic veins.
Right hepatic vein divides the right lobe into anterior and posterior segments.
Middle hepatic vein divides the liver into right and left lobes (or right and left hemiliver). This plane runs from the inferior vena cava to the gallbladder fossa.
Left hepatic vein divides the left lobe into a medial and lateral part.
Portal vein divides the liver into upper and lower segments.
The left and right portal veins branch superiorly and inferiorly to project into the center of each segment.
Because of this division into self-contained units, each segment can be resected without damaging those remaining. For the liver to remain viable, resections must proceed along the vessels that define the peripheries of these segments. This means, that resection-lines parallel the hepatic veins,
The centrally located portal veins, bile ducts, and hepatic arteries are preserved.
Clockwise numbering of the segments Segments numbering
There are eight liver segments.
Segment 4 is sometimes divided into segment 4a and 4b according to Bismuth.
The numbering of the segments is in a clockwise manner (figure).
Segment 1 (caudate lobe) is located posteriorly. It is not visible on a frontal view.
On a frontal view of the liver the posteriorly located segments 6 and 7 are not visible.
The illustrations above are schematic presentations of the liversegments.
In reality however the proportions are different.
On a normal frontal view the segments 6 and 7 are not visible because they are located more posteriorly.
The right border of the liver is formed by segment 5 and 8.
Although segment 4 is part of the left hemiliver, it is situated more to the right.
Couinaud divided the liver into a functional left and right liver (in French 'gauche et droite foie') by a main portal scissurae containing the middle hepatic vein. This is known as Cantlie's line.
Cantlie's line runs from the middle of the gallbladder fossa anteriorly to the inferior vena cava posteriorly.
On this illustration it looks as if the medial part of the left lobe is separated from the lateral part by the falciform ligament. However it actually is the left hepatic vein, that separates the medial part (segment 4) from the lateral part (segments 2 and 3).
The left hepatic vein is located slightly to the left of the falciform ligament.
LEFT: above the level of the left portal vein.
RIGHT: at the level of the left portal vein Transverse anatomy
The far left figure is a transverse image through the superior liver segments, that are divided by the hepatic veins.
The right figure shows a transverse image at the level of the left portal vein.
At this level the left portal vein divides the left lobe of the liver into the superior segments (2 and 4A) and the inferior segments (3 and 4B).
The left portal vein is at a higher level than the right portal vein.
LEFT: at the level of the right portal vein.
RIGHT: at the level of the splenic vein.
The image on the far left is at the level of the right portal vein. At this level the right portal vein divides the right lobe of the liver into superior segments (7 and 8) and the inferior segments (5 and 6).
The level of the right portal vein is inferior to the level of the left portal vein.
At the level of the splenic vein, which is below the level of the right portal vein, only the inferior segments are seen (right image).
Hypertrophy of caudate lobe in a patient with livercirrhosis. Notice the small lobulated right hemiliver. Caudate lobe
The caudate lobe or segment 1 is located posteriorly.
The caudate lobe is anatomically different from other lobes in that it often has direct connections to the IVC through hepatic veins, that are separate from the main hepatic veins.
The caudate lobe may be supplied by both right and left branches of the portal vein.
On the left a patient with cirrhosis with extreme atrophy of the right lobe, normal volume of the left lobe and hypertrophy of the caudate lobe.
Due to a different blood supply the caudate lobe is spared from the disease process and hypertrophied to compensate for the loss of normal liverparenchyma
Neurovascular Neuropsychology
Neurovascular Neuropsychology
Springer | ISBN: 90387707131 | 22009-05-15 | PDF | 566 pages | 4 Mb
Springer | ISBN: 90387707131 | 22009-05-15 | PDF | 566 pages | 4 Mb
Download Link
Cosmetic Dermatology : Principles and Practice
Cosmetic Dermatology : Principles and Practice, 2nd Edition
McGraw-Hill Professional | 2009-04-08 | ISBN: 0071490620 | 336 Pages | PDF | 17 MB
McGraw-Hill Professional | 2009-04-08 | ISBN: 0071490620 | 336 Pages | PDF | 17 MB
Download Link
Anatomy of the Human Body Henry Gray
Anatomy of the Human Body
Henry Gray
The Bartleby.com edition of Gray’s Anatomy of the Human Body features 1,247 vibrant engravings—many in color—from the classic 1918 publication, as well as a subject index with 13,000 entries ranging from the Antrum of Highmore to the Zonule of Zinn
Henry Gray
The Bartleby.com edition of Gray’s Anatomy of the Human Body features 1,247 vibrant engravings—many in color—from the classic 1918 publication, as well as a subject index with 13,000 entries ranging from the Antrum of Highmore to the Zonule of Zinn
TWENTIETH EDITION
THOROUGHLY REVISED AND RE-EDITED BY WARREN H. LEWIS
ILLUSTRATED WITH 1247 ENGRAVINGS
PHILADELPHIA: LEA & FEBIGER, 1918
NEW YORK: BARTLEBY.COM, 2000
THOROUGHLY REVISED AND RE-EDITED BY WARREN H. LEWIS
ILLUSTRATED WITH 1247 ENGRAVINGS
PHILADELPHIA: LEA & FEBIGER, 1918
NEW YORK: BARTLEBY.COM, 2000
I. Embryology
The Extremities
http://www.bartleby.com/107/49.html
http://www.bartleby.com/107/50.html
http://www.bartleby.com/107/51.html
http://www.bartleby.com/107/52.html
http://www.bartleby.com/107/54.html
http://www.bartleby.com/107/57.html
http://www.bartleby.com/107/61.html
vessels
http://www.bartleby.com/107/142.html
http://www.bartleby.com/107/157.html
http://www.bartleby.com/107/165.html
Stem Cells , Human Embryos and Ethics : Interdisciplinary Perspectives
Stem Cells , Human Embryos and Ethics : Interdisciplinary Perspectives
Publisher: Springer | ISBN: 140206988X | Edition 2008 | PDF | 268 Pages | 2,2 MB
Download Link
Publisher: Springer | ISBN: 140206988X | Edition 2008 | PDF | 268 Pages | 2,2 MB
Download Link
الجمعة، 14 أغسطس 2009
Forensic Science
Forensic Science
Salem Press | 2008-10-17 | ISBN : 1587654239 | Pages: 1056 | PDF | 17.33 MB
Salem Press | 2008-10-17 | ISBN : 1587654239 | Pages: 1056 | PDF | 17.33 MB
Download Link
Recent Advances in Transthyretin Evolution, Structure and Biological Functions
Recent Advances in Transthyretin Evolution , Structure and Biological Functions
Springer | 2009 | ISBN: 3642006450 | 374 Pages | PDF | 5 MB
Springer | 2009 | ISBN: 3642006450 | 374 Pages | PDF | 5 MB
Download Link
0R
الأربعاء، 12 أغسطس 2009
Alzheimer’s Disease Symptoms and Stages
Alzheimer’s disease is the most common form of dementia, a serious brain disorder that impacts daily living through memory loss and cognitive changes. Alzheimer’s is a degenerative disease, progressing from mild forgetfulness to widespread neurological impairment and ultimately death. Chemical and structural changes in the brain gradually destroy the ability to create, remember, learn, reason, and relate to others. As critical cells die, drastic personality loss occurs and body systems fail.
Although not all memory loss indicates Alzheimer’s disease, one in ten people over 65 years of age, and over half of those 85+ have Alzheimer’s disease. Currently, 26 million people worldwide have this dementia, and over 15 million Americans will be affected by the year 2050.
Early-onset Alzheimer’s effects patients under the age of 65. This relatively rare condition is seen more often when parents or grandparents developed Alzheimer’s disease at a young age, and is generally associated with three genetic markers.
Early-onset Alzheimer’s effects patients under the age of 65. This relatively rare condition is seen more often when parents or grandparents developed Alzheimer’s disease at a young age, and is generally associated with three genetic markers.
Signs and symptoms that may mean Alzheimer’s disease
For many, recognition of memory problems in themselves or a loved one brings fear of Alzheimer’s disease. Age-related brain shrinkage does produce normal changes in processing speed, attention, and short term memory, creating so-called “senior moments.” Understanding significance begins with knowing what is normal.SIGNS OF NORMAL CHANGE VS. EARLY ALZHEIMER’S SYMPTOMS
*Normal
$Early Alzheimer’s disease
*Can’t find your keys
$Routinely place important items in odd places
*Search for casual names and words
$Forget names of family and common objects
*Briefly forget conversation details
$Frequently forget entire conversations
*Can’t find a recipe
$Can’t follow recipe directions
*Forget to write down a check
$Can no longer manage checkbook
*Cancel a date with friends
$Withdraw from usual interests
*Miss an occasional right turn
$Get lost in familiar places
What else might be causing these symptoms?
Significant cognitive and memory losses are not symptoms of normal aging. Most people over 65 experience a level of forgetfulness that is merely inconvenient and generally involves unimportant information. Terms like eccentric and senile can mask fears of Alzheimer’s disease, while other conditions may actually be causing mental decline.
Symptoms that mimic early Alzheimer’s disease may result from:
Central nervous system and other degenerative disorders-, head injuries, brain tumors, stroke, epilepsy, Pick’s Disease, Parkinson’s disease, Huntington’s disease
Metabolic ailments- hypothyroidism, hypoglycemia, malnutrition, vitamin deficiencies, dehydration, kidney or liver failure
Substance-induced conditions-drug interactions, medication side-effects, alcohol and drug abuse
Psychological factors- dementia syndrome, depression, emotional trauma, chronic stress, psychosis, chronic sleep deprivation, delirium
Infections- meningitis, encephalitis, and syphilis
What to do if you notice Alzheimer’s symptoms
Research shows Alzheimer’s disease causes more worry than any other condition for Americans over 55 years of age. If your family history includes Alzheimer’s and you find yourself forgetting things, it doesn’t necessarily mean you have this disease. Even when you fear the worst, it is important to share your concerns and seek expert advice.
Why not just wait and see?
When symptoms appear suddenly, it is critical to seek medical attention. Conditions such as stroke, drug interactions, tumors, and seizures should be treated immediately. Timely intervention may also control or eliminate symptoms from other physical and psychological factors.
If your symptoms are the result of Alzheimer’s disease, medications can delay the onset of more debilitating symptoms. Early diagnosis can prolong independence and is the first step towards treatment, management, and living life fully.
Ten Warning Signs of Alzheimer’s
According to the Alzheimer’s Association, the ten warning signs are:
Memory loss
Difficulty performing familiar tasks
Problems with language
Disorientation to time and place
Poor or decreased judgment
Problems with abstract thinking
Misplacing things
Changes in mood or behavior
Changes in personality
Loss of initiative
Where should I go if I suspect Alzheimer’s?
Although no single test for Alzheimer’s exists, a skilled general practitioner, neurologist, or geriatrician can make a reasonable diagnosis by excluding other causes of your symptoms. Begin by preparing a list of concerns to discuss with your doctor. Ask a family member or friend to go with you to take notes and help you remember your questions. If your doctor suspects Alzheimer’s disease and recommends further assessment, ask for support and information from your local Alzheimer’s Association while you wait for a diagnosis.
Can I prevent or inhibit Alzheimer’s disease?
With each forgotten name or misplaced item, memory loss can be frightening. Maintaining a brain-healthy lifestyle, understanding controllable risk factors, and participating in research studies, can increase your sense of empowerment and protect your memory.
For many, recognition of memory problems in themselves or a loved one brings fear of Alzheimer’s disease. Age-related brain shrinkage does produce normal changes in processing speed, attention, and short term memory, creating so-called “senior moments.” Understanding significance begins with knowing what is normal.SIGNS OF NORMAL CHANGE VS. EARLY ALZHEIMER’S SYMPTOMS
*Normal
$Early Alzheimer’s disease
*Can’t find your keys
$Routinely place important items in odd places
*Search for casual names and words
$Forget names of family and common objects
*Briefly forget conversation details
$Frequently forget entire conversations
*Can’t find a recipe
$Can’t follow recipe directions
*Forget to write down a check
$Can no longer manage checkbook
*Cancel a date with friends
$Withdraw from usual interests
*Miss an occasional right turn
$Get lost in familiar places
What else might be causing these symptoms?
Significant cognitive and memory losses are not symptoms of normal aging. Most people over 65 experience a level of forgetfulness that is merely inconvenient and generally involves unimportant information. Terms like eccentric and senile can mask fears of Alzheimer’s disease, while other conditions may actually be causing mental decline.
Symptoms that mimic early Alzheimer’s disease may result from:
Central nervous system and other degenerative disorders-, head injuries, brain tumors, stroke, epilepsy, Pick’s Disease, Parkinson’s disease, Huntington’s disease
Metabolic ailments- hypothyroidism, hypoglycemia, malnutrition, vitamin deficiencies, dehydration, kidney or liver failure
Substance-induced conditions-drug interactions, medication side-effects, alcohol and drug abuse
Psychological factors- dementia syndrome, depression, emotional trauma, chronic stress, psychosis, chronic sleep deprivation, delirium
Infections- meningitis, encephalitis, and syphilis
What to do if you notice Alzheimer’s symptoms
Research shows Alzheimer’s disease causes more worry than any other condition for Americans over 55 years of age. If your family history includes Alzheimer’s and you find yourself forgetting things, it doesn’t necessarily mean you have this disease. Even when you fear the worst, it is important to share your concerns and seek expert advice.
Why not just wait and see?
When symptoms appear suddenly, it is critical to seek medical attention. Conditions such as stroke, drug interactions, tumors, and seizures should be treated immediately. Timely intervention may also control or eliminate symptoms from other physical and psychological factors.
If your symptoms are the result of Alzheimer’s disease, medications can delay the onset of more debilitating symptoms. Early diagnosis can prolong independence and is the first step towards treatment, management, and living life fully.
Ten Warning Signs of Alzheimer’s
According to the Alzheimer’s Association, the ten warning signs are:
Memory loss
Difficulty performing familiar tasks
Problems with language
Disorientation to time and place
Poor or decreased judgment
Problems with abstract thinking
Misplacing things
Changes in mood or behavior
Changes in personality
Loss of initiative
Where should I go if I suspect Alzheimer’s?
Although no single test for Alzheimer’s exists, a skilled general practitioner, neurologist, or geriatrician can make a reasonable diagnosis by excluding other causes of your symptoms. Begin by preparing a list of concerns to discuss with your doctor. Ask a family member or friend to go with you to take notes and help you remember your questions. If your doctor suspects Alzheimer’s disease and recommends further assessment, ask for support and information from your local Alzheimer’s Association while you wait for a diagnosis.
Can I prevent or inhibit Alzheimer’s disease?
With each forgotten name or misplaced item, memory loss can be frightening. Maintaining a brain-healthy lifestyle, understanding controllable risk factors, and participating in research studies, can increase your sense of empowerment and protect your memory.
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